‘The Good Nurse,’ by Charles Graeber

By JANET MASLIN

April 11, 2013

In 2003, the world discovered what a night nurse named Charles Cullen had been doing during the preceding 16 years. He had killed a judge, a priest and an unknown but large number of other people. He may have been the most prolific serial killer in history.

Though he had worked at nine hospitals in New Jersey and Pennsylvania, and some of his supervisors were aware of his dangerously unorthodox treatment of patients (“Would not consider for rehire — medication issue,” one wrote on his record), he was clever enough to remain unnoticed. When his killings finally came to light, they revealed more about how the hospitals’ systemic and ethical failings had protected him than about the colorless, uncommunicative murderer himself.

That might have remained the case if Mr. Cullen had not been asked to save a life instead of take one. But in 2005 he was approached about donating a kidney to the brother of one of his estranged ex-girlfriends. The ensuing uproar caught the interest of Charles Graeber, who spotted a news item about the killer-kidney fracas. Mr. Graeber went to work on what would eventually become a 2007 New York magazine article, “The Tainted Kidney.” As he worked on it, Mr. Graeber says, he became the only journalist with whom Mr. Cullen would correspond.

Now Mr. Graeber has compiled the full Cullen story into “The Good Nurse,” a stunning book with a flat, uninflected title that should and does bring to mind “In Cold Blood.” Mr. Graeber was well aware that to immortalize this nurse’s chilling deeds was to exploit them; promoting the book may have the same effect.

Both he and Mr. Cullen know that the story appeals to prurient interests, as does any graphic tale of true crime. But “The Good Nurse” succeeds in being about much more than Mr. Cullen’s murderous kinks. The causes of his pathology are not interesting. But the eagerness of ambitious hospital administrators to cover up his misdeeds is revelatory. And the police investigation that brought him down is a thriller in every sense of that word.

Mr. Cullen’s relative facelessness (“a sad Mr. Rogers type, both drippy and depressed”) gives the book an advantage. The man was such a cipher that it’s not possible to identify with him in any way. Perhaps his poor eyesight played a role in his choice of victims, but we don’t even know that for sure. Mr. Cullen’s most compelling characteristics were a sophisticated knowledge of hospital protocols, an uncanny grasp of medical brinkmanship and an icy determination to game any institution foolish enough to take him in.

Charles Graeber

Gabrielle V. Allen

The first half of “The Good Nurse,” a litany of the crimes, is only a prelude. And it is relentlessly grim, since the killings are so impersonal. Yes, there’s a word or two about Mr. Cullen’s miserable childhood and penchant for suicide attempts, but the book soon moves on to the burn-unit training that may have shaped Mr. Cullen’s fatalism about patients fighting for their lives. Mr. Graeber, who has been drawn to extremes throughout his reporting career (as in a recent, award-nominated Wired article that drew him close to Kim Dotcom, the Internet pirate), brings a bit more gusto than necessary to describing the ghastliness of burn damage. “Some pain blossomed across skin in crenulated carnations of tissue, some blistered or knifed in thin white stalks,” he writes.

At first Mr. Cullen began tampering with the contents of IV bags. Insulin shock was one of his favorite outcomes, although he seems not to have paid much attention to what his victims actually experienced. Among the technically fascinating aspects of this story are the ways Mr. Cullen used hospital systems for browsing, keeping track of patients he had poisoned and picking challenging new targets.

Another is his command of the Pyxis automated dispensing system that gave him access to drugs. Before the system was upgraded Mr. Cullen could order a deadly drug (digoxin, used to treat congestive heart failure, was a great favorite), remove it from the machine and then cancel the order. Eventually, when a nurse named Amy Loughren began monitoring her friend Charlie’s activities for Somerset County detectives in New Jersey, she saw that he ordered and canceled drugs from the dispenser many times more often than an ordinary, lifesaving nurse would.

Mr. Graeber documents various hospitals’ efforts to know as little as possible about Mr. Cullen’s activities. At the risk of their patients’ lives, they did not want their institutional reputations damaged. But soon after he started work at Somerset Medical Center in Somerville, N.J., a smart pair of cops, Detective Sgt. Tim Braun and Detective Danny Baldwin, who would be commended for their extraordinary efforts, took up the investigation. They were immediately struck by the paucity of records about Mr. Cullen and the eagerness of hospital lawyers to deflect them. It took five months for Somerset Medical Center to acknowledge that it had five “unexplainable patient incidents” on its hands.

This hospital’s behavior (and that of others described in the book) would be ludicrous if it did not involve the deaths of patients. “Nothing comes to mind,” a Somerset lawyer told them, though another was willing to describe Cullen as an odd duck. The investigators were lied to so egregiously that they were told by a hospital “risk manager” that the Pyxis didn’t keep long-term records, so there would be no point checking on Mr. Cullen’s history. But a call to the Pyxis’s manufacturer indicated otherwise. “Just pull it up,” Detective Baldwin was told. “Is there something wrong with your machine?”

And so it goes, with sudden breakthroughs and eureka moments. A big one occurred when Ms. Loughren, the most important witness in the book, was told by a hospital official that she should deflect the detectives’ inquiries to a hospital lawyer.

“O.K.,” she told the detectives, hanging up the phone. “Turn on your tape recorder, boys, and tell me what you want to know.”